The best course of action may be to delay any treatment for prolapse until symptoms become bothersome

In a linked paper (doi:10.1136/bmj.g7378), Wiegersma and colleagues report a well designed randomized trial evaluating pelvic floor muscle training for women with mild symptomatic pelvic organ prolapse.1 Fifty seven per cent of women in the intervention group reported an overall improvement in prolapse related symptoms over three months, compared with 13% of controls managed with watchful waiting (P<0.001).

Women given pelvic floor muscle training also improved by on average 9.1 (95% confidence interval 2.8 to 15.4) points more on a validated symptom scale (the Pelvic Floor Distress Inventory-20, range 0-300) than did controls. However, this difference, although statistically significant, was too small to be noticeable clinically. The minimum clinically relevant difference on this scale is 15 points. As the authors mention, the three month treatment duration may not have been long enough to make any appreciable difference to symptoms. Pelvic floor muscle training works by strengthening the muscles of the pelvic floor and providing women with valuable biofeedback as to how to control their pelvic floor. This process …